Provider Demographics
NPI:1649387143
Name:RUMBLE, MARK RICHARD (DDS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:RICHARD
Last Name:RUMBLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 SOUTH MAIN STREET
Mailing Address - Street 2:SUITE 121
Mailing Address - City:ALBION
Mailing Address - State:NY
Mailing Address - Zip Code:14411
Mailing Address - Country:US
Mailing Address - Phone:585-589-9044
Mailing Address - Fax:585-589-1265
Practice Address - Street 1:243 SOUTH MAIN STREET
Practice Address - Street 2:SUITE 121
Practice Address - City:ALBION
Practice Address - State:NY
Practice Address - Zip Code:14411
Practice Address - Country:US
Practice Address - Phone:585-589-9044
Practice Address - Fax:585-589-1265
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038730-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice